The healthcare system is complicated. It’s often difficult for patients to navigate on their own, as they are interacting with several physicians, nurses, other medical professionals, along with billing and insurance companies.
The goal has been to ensure that as many people as possible are receiving coverage, but the consensus is that it’s time to shift that goal and see to it that all patients are receiving the best care possible.
What do Patients need From Healthcare Delivery?
Patients deserve better outcomes at lower costs. Grant Makers in Health or GIH reference the “triple aim” as a solution.
The Triple Aim
The triple aim splits the goal into three definable categories and it’s important to remember that good performance in one does not guarantee the other.
What is the triple aim?
The triple aim in the US healthcare system needs to pursue three main aims simultaneously. That includes:
- Improving patient care experiences like the quality of care and satisfaction
- Improving the health of the people and population
- Reducing the cost per capita of healthcare
Care coordination integrates an emphasis on the process, the long-term outcomes, and the cost. Evaluating how a patient is cared for, if the care was effective, and if it was worth the cost will require better communication across all channels of the healthcare system that the patient is involved in.
For patients that are a part of the healthcare system, meaning they are insured and/or receive regular care, the process has not been optimized. Healthcare is considered costly and outcomes are not always satisfactory to the patient. For those that are not a part of the healthcare system, those costs and outcomes are even less desirable.
The Commonwealth Fund Commission on a High-Performance Health System identifies needed focuses in transforming care delivery for patients.
- Patient-data-driven technology that is easily accessible across the healthcare system.
- Care coordination among providers and an emphasis on transitions between services.
- Greater accountability, collaboration, and peer reviews among providers.
- Accessible information to patients and providing them with education.
- Increased outcome reviews and accountability.
While these attributes may be present in some healthcare delivery systems, the goal is to see care coordination emphasized in all-new structure experiments of healthcare delivery systems such as hospital-at-home care, coordinated care organizations, PACE programs, managed care organizations, senior centers, patient-centered medical homes, along with the systems already in place such as hospitals and physician’s offices.
What Will it Take to Transform Healthcare Delivery?
Transforming the healthcare delivery system, with time, will take both local and broad-scale investment and change. Care coordination and communication will be key.
1 An emphasis on teamwork
Workforce strategy must be emphasized. If the patient is being sent to multiple healthcare providers, is everyone involved communicating the patient’s needs? Teamwork and communication can prevent patients from being given “the run-around” or time and resources being wasted due to overlapping processes.
2 Patient-centered outcomes research
Information on the relative effectiveness of care which the patient is receiving is vital when considering the cost and the systems in place. Investing in quality measurement to determine at what scale the patient’s health has helped will provide hard data that can lead to greater incentive when it comes to healthcare delivery reform.
3 Better healthcare data management and communication technology integration
Healthcare technology companies like Rainbow Health are working to create platforms that make it easier than ever for providers and medical professionals to access and share their patient’s information with the appropriate people. Having a digital space to communicate needs with those invested in the patient’s health and well-being is imperative. This can mean a quick view at scheduled appointments, lab results, or something as simple as ensuring that the patient has food or a ride system.
4 Better provider payment systems
Provider payment systems are one of the greatest obstacles in transforming healthcare delivery for patients. Too often providers are unintentionally rewarded for a duplication of services, unnecessary services, and cost-escalating activities. These issues can be minimized by better communication among providers and outcome-based data being utilized.
Who is Working towards Healthcare Delivery Transformation?
Anyone involved in healthcare may see the need for better systems to be put into place, and many work towards transforming healthcare delivery in several different ways.
1 Centers for Medicare & Medicaid Services
The CMS Innovation Center, also known as ‘CMMI’, works toward innovative new healthcare delivery models being run across the nation, with a focus on meeting different patient’s needs in a variety of settings. They are geared towards better care at better costs and also emphasize the importance of better payment models or APMs.
2 Healthcare Provider Networks
Healthcare provider networks have already begun to implement better technology and communication systems into their practices, allowing for a more cohesive approach towards healthcare. The provider’s main focus is the patient, and taking the extra time to implement better systems is what will ultimately benefit the patient.
With healthcare provider integration, health plans can negotiate better rates which in turn benefits the patient. Health plans work to develop better care incentives. According to GIH, “Plans with looser and less exclusive networks work to influence the delivery practices by altering the payment incentives as a part of efforts to spur the desired changes like quality improvement initiatives, or investments in information management infrastructure.”
The Cost of Transforming Healthcare Delivery
Patients are too often admitted to the hospital or given overlapping/duplicated treatments due to poor communication and an emphasis on a payment incentive over quality care. Changing the financial incentives of our healthcare system will mean setting incentives for meaningful and quality care. In turn, this will lead to better allocation of time and resources within the healthcare system, ultimately saving money.
Care Coordination is Key in Transforming Healthcare Delivery For Patients
Care coordination is geared towards innovative optimization of healthcare delivery. It puts the patients’ needs first and works to organize systems that allow for high-functioning communication among patients, providers, and caregivers. It allows for more data-driven decision-making and targeting of high-need patients. Care coordination reduces re-admittance to emergency rooms, and it is preventative in that it is more consistently monitoring the patients and identifying potential needs.